Basic Information
| Provider Information | |||||||||
| NPI: | 1164717518 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHEPHERD | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | LOWELL | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727450550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794637775 | ||||||||
| FaxNumber: | 4794637187 | ||||||||
| Practice Location | |||||||||
| Address1: | 3336 N FUTRALL DRIVE | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794633000 | ||||||||
| FaxNumber: | 4794633050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2011 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 55460 | MN | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207T00000X | E-11111 | AR | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.